KEY TAKEAWAYS
- The study aimed to investigate the efficacy of square excision of the NAC and X-shaped purse-string closure post-implant reconstruction.
- The study concluded that square NAC excision and two-stage TE reconstruction reduce incisions and complications.
Skin-sparing mastectomy (SSM), commonly employed in breast cancer cases where tumor placement precludes nipple-sparing mastectomy (NSM).
Melika Zarei and the team aimed to evaluate the effectiveness of square excision of the nipple-areolar complex (NAC) and X-shaped purse-string closure post-implant-based reconstruction.
A retrospective review analyzed patients who underwent periareolar SSM and immediate implant-based reconstruction from January 2015 to December 2022. Specifically, it identified cases with square NAC excision and closure.
About 29 patients meeting inclusion criteria underwent 54 periareolar SSM and immediate implant-based reconstruction procedures (25 bilateral, 4 unilateral). Surgical indications included cancer (30 cases) and prophylactic (24 cases, with 2 patients having bilateral cancer). Reconstructive methods comprised tissue expander (TE) in 36 cases (66.7%) and direct-to-implant (DTI) in 18 cases (33.3%).
Mean mastectomy weights and final implant sizes were similar across both groups. Wound complications were observed in 13 breasts (24.1%), including mastectomy skin flap necrosis (MSFN) in 10 (18.5%) and infection in 3 (5.6%).
Reconstructive failure occurred in 3 cases: 1 in the TE group due to infection and 2 in the DTI group due to MSFN/exposure. MSFN rates differed between TE (4 cases, 11.1%) and DTI (6 cases, 33.3%) methods (P= 0.05). Mean initial TE fill volume was 247.1 cc, while mean implant size in the DTI group was 417.8 cc (P< 0.0001).
The study concluded that square excision of the NAC and closure can effectively reduce surgical incisions in implant reconstruction. Additionally, employing two-stage TE reconstruction allows for lower initial fill volumes, decreasing the risk of MSFN after box to X closure of SSM and implant-based reconstruction. This approach proves beneficial particularly in patients with small to moderate-sized breasts and mild ptosis who are not suitable candidates for NSM.
No funding related information was available.
Source: https://pubmed.ncbi.nlm.nih.gov/38857011/
Zarei M, Carlson GW. (2024). “Periareolar Skin-Sparing Mastectomy and Immediate Implant-Based Reconstruction: A Reappraisal.” Ann Plast Surg. 2024 Jun 1;92(6S Suppl 4):S441-S444. doi: 10.1097/SAP.0000000000003946. PMID: 38857011.
